Integration
in
Medical Education
AMAL AL-OTAIBI
CP, MME
OBJECTIVES
Define “curriculum”,
Identify different types of curricula,
Identify the content structures of a curriculum,
List different educational strategies.
Define integration.
Identify types of integration
Identify rationale for integrated learning
Identify the advantages & disadvantages.
What is a
curriculum??
What is a curriculum?
• The curriculum is the content or objectives for
which school hold students accountable.
• The curriculum is the set of instructional strategies
teachers plan to use.
• These conceptual differences are based on
distinction between a curriculum as expected end
of education (Intended learning outcomes),
and a curriculum as the expected means of
education (Instructional plans).
What is a curriculum?
• A curriculum is about what should happen in a
teaching program – about the intension of the
teachers and about the way they make this
happen.
• The curriculum in fact is
 What the student learns
 How the student learns (strategy/s &
Learning/teaching tools)
 How the student assessed
 The learning environment
 Learning outcomes
Types of Curriculum:
1- The official curriculum: (The written
curriculum):
“It is documented according to a common theme and to
successive grade levels with curriculum guide, course
outlines, and list of objectives.”
The purpose is to give
Teachers a basis of planning for lessons and
assessing students
Administrators a basis for supervising teachers and
holding them accountable for their practices and
results.
2-The Operational Curriculum
• What is actually taught by the teachers and how
it is communicated.
• This includes what the teacher teaches in the
class and the learning outcome for the students.
3- Hidden Curriculum
• Includes the norms and values of the
surrounding society.
• It is not part of the either the official or
operational curricula.
• It has a deeper and durable impact on students.
4- The Null Curriculum
• Subject matters that is not taught at all although
they appear to be important.
• E.g. Student’s Psychology, Parenting (how to
teach and care for student).
5- Extra Curriculum
• All planned experiences outside the school
subject.
• It contrasts with the official curriculum by its
responsiveness to students.
• E.g. Sports, social programs, competition
programs
Different curricular models
• Outcome-Based Education- What sort of
doctor is needed?
 What the doctor able to do
Doing the right thing
 How the doctor approaches his practice
Doing the thing right
 The doctor as a professional
The right person is doing it
Different curricular models
• Problem-Based Learning
• Task-Based Learning
▫ A range of tasks undertaken by a doctor are
identified. E.g. Management of a patient with
abdominal pain which is used as the focus for
learning.
• An Integrated system-based approach.
• Community-Based Education
Basic curricular structures
• The discrete curriculum,
• The linear curriculum,
• The pyramidal structure, AND
• The spiral curriculum.
Basic curricular structures
• The discrete curriculum
 The self-sufficient programs: unrelated or
independent contents
A
B
C
D
The linear curriculum
• Each concept or skill of the content need the
mastery of the previous concept or skill.
• Called Mastery Learning Strategies
(Bloom,1871)
A
B
▫ Linear Configuration
C
D
The pyramidal structure
• Multiple unrelated concepts or skills for learning
subsequent concepts or skills.
A
C
B
D
E
F
G
The spiral curriculum
• Organization of concepts and skills
• There is interactive revisiting of topics
throughout the block
• Topics are revisited at numerous levels of
difficulty
• New learning is strongly related to previous
learning.
• The competence of students increases with each
visit to a topic.
Educational strategies
• Six educational strategies have been identified in
relation to curriculum in medical schools by Prof
Harden.
• Each strategy can be represented as a spectrum
or continuum:






Student-centered/teacher-centered
Problem-based/information-gathering
Integrated/discipline-based
Community-based/hospital-based
Elective/uniform
Systematic/opportunistic
Educational strategies
• Six educational strategies have been identified in
relation to curriculum in medical schools by Prof
Harden.
• Each strategy can be represented as a spectrum
or continuum:






Student-centered/teacher-centered
Problem-based/information-gathering
Integrated/discipline-based
Community-based/hospital-based
Elective/uniform
Systematic/opportunistic
SPICES Model of Educational Strategies
• Student centered
• Teacher centered
▫ “What the student learn rather than what is taught"
• Problem-based
• Information-oriented
• Integrated or Inter-professional
• Subject or Discipline-based
Integration throughout the curriculum
• Community-based
Less emphasis on hospital-based
programs
• Hospital-based
SPICES Model of Educational Strategies
• Elective-driven
According to student needs
learning & teaching adjusted to the needs
of students
• Systematic
• Uniform
• Opportunistic
Think, Pair & Share:
What is Integration??
Abraham Flexner Recommendations:
• Under Flexner’s influence, medical curricula
around the world came to be structured into:
• Preclinical medicine: learned in lecture
theatres, teaching laboratories, dissecting
rooms, and libraries
• Clinical medicine: learned in wards and
operating theatres of university tertiary hospitals
• In the late twentieth century,
national bodies began to respond to
the wind of change to meet patients’
needs to be achieved through
curriculum integration.
• Disciplines should integrate their
contributions into a thematic,
probably systems-based curriculum
• Integration was one of the key
criteria for assessing the degree of
innovation in a medical curriculum
in the SPICES curriculum model
(Harden, 1984).
Old Curriculum
Basic Sciences:
•Anatomy
•Physiology
•Pathology/Immunology/Microbiology….
•Biochemistry
•Pharmacology
Clinical:
•Medicine, surgery, Ob/Gyn, Peadiatrics,
•ENT/Oph….
Learn like doctor & think like doctor
…because human beings are complex
organisms whose discrete systems are
linked intricately and elaborately within
the body and modified profoundly by
external influences, we need to teach in
ways that reflect this complexity and that
stimulate students to synthesize information
across disciplines.
Dienctag
Learn like doctor & think like doctor
A sick patient does not represent a biochemistry
problem, an anatomy problem, a genetics
problem, or an immunology problem; rather,
each person is the product of myriad molecular,
cellular, genetic, environmental, and social
influences that interact in complex ways to
determine health and disease.
Dienctag
“ The teaching of different subject areas
in a thematic manner, so that the
different disciplines are not emphasized”
Internal dictionary of Adult & CME
“ The organization of teaching of matter
to interrelate or unify subjects frequently
taught in separate academic courses or
departments”
Harden
Curriculum
Integration
The rationale
• Curriculum organization denotes a systematic
arrangement of curriculum elements,
• It will results in a more relevant, meaningful, and
student centered curriculum,
• Integration makes the learning contexts close in
which the information is to be retrieved.
Advantages
1. Matching curriculum aims.
2. Achieving higher level of
objectives.
3. Avoiding information overload.
4. Making learning interesting &
effectives
5. Motivating students.
Disadvantages
1. Loosing subject identity.
2. Requiring interdepartmental
planning.
3. Resources shortage.
Types of
Integration
Vertical
integration
Horizontal
Integration
Summary
Summary
Learning take place better if it is contextual.
Overcrowding information could be solved by
integration.
Integration is the necessity & not the luxury.
This is the relatively new trend which has been
applied in med education every where.
I wish you a very successful and
enjoyable time in your course
All the best